mbj-dec-2010-mmi

Medical Business Journal

Medical Business Journal - MMIclasses.com - Issue 5, Volume 1 - December 2010 1

GAO releases first annual review of NQFShows NQF’s progress related to MIPPA quality measures

The National Quality Forum (NQF) was awarded a contract in Jan. 2009, with the Department of Health and Human Services (HHS), in order to monitor quality measures mandated by the Medicare Improvements for Patients and Providers Act (MIPPA). The US Government Accountability Office (GAO) released its first required annual review of NQF’s progress.

NQF, a nonprofit member organization, has five duties required of it by MIPPA:1) Make recommendations on a national strategy and priorities2) Endorse quality measures, which involves a process for determining which ones should be recognized as national standards3) Maintain—update or retire—endorsed quality measures4) Promote electronic health records5) Report annually to Congress and the Secretary of HHS

While the GAO report stated that it was too soon to judge the effectiveness of NQF at accomplishing these duties, the report gave an account of NQF’s progress thus far.

NQF has established a committee of stakeholders to recommend strategies and priorities for quality measurement. The committee published a list of recommended priorities in May 2010. NQF is developing a national standard to be proposed to HHS, which will then submit their proposal to Congress by Jan. 1, 2011.

NQF has also established a process for endorsing quality measures. Organizations develop quality measures and submit them to NQF in response to solicitations by NQF. NQF then forms a committee of experts collected from its member organizations to consider these

(Cont. Page 2 NQF)

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Medical Business Journal - MMIclasses.com - Issue 5, Volume 1 - December 2010


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NQF cont. from page 1measures against pre-determined criteria. A period for public comment is then provided. NQF’s board of directors then makes a final decision on the national standard, which is formally endorsed by NQF and submitted to HHS.

Once a measure is established, NQF will provide annual updates and every three years a comprehensive review of the measure. The comprehensive review is similar to the initial process for endorsing a quality measure, going from committee to public review then to the board of directors. NQF is currently reviewing 191 measures that were already in place at the start of its contract.

NQF has begun developing a standardized set of data that all electronic health records (EHRs) must include. This is intended to provide a standard by which EHRs may be judged on a national level.

Two annual reports have been submitted by NQF, one in March 2009 and the second in March 2010. HHS has then reviewed the reports and approved annual plans developed by NQF.

A full copy of the report in pdf format is available at:http://www.gao.gov/new.items/d10737.pdf

NimbleTM EMR Released by ClearPracticeComprehensive EMR created specifically for iPadTM

One of the main draws of adopting electronic medical records (EMRs) is their mobility, compared to paper records. It only makes sense to put these mobile records on a mobile device, in this case the iPadTM.

Doctors need to be able to access their patient’s records on the go, whether doing their rounds or sitting at home. One of the largest sources of resistance to EMR technology has been the inability for a doctor to carry a large desktop computer around with them when they are seeing their patients. It is for this reason that ClearPractice developed the NimbleTM EMR for the iPadTM.

NimbleTM connects via a wireless or 3G network to the ClearPractice cloud, where it stores all of its data. This makes the app both secure and HIPPA compliant. NimbleTM allows doctors to access patient charts while making their rounds, and lets the doctors show the patients charts and graphics to better explain their condition and course of treatment.

Additionally, NimbleTM integrates with ClearPractice’s practice management and billing systems to automatically capture charges and submit them for payment electronically. NimbleTM relies on ClearPractice’s Software as a Service (SaaS) system, meaning that the software and data is stored remotely and accessed by the user via NimbleTM. This allows for instantaneous updates managed remotely by ClearPractice.

A video advertisement for NimbleTM is available on YouTube at: http://www.youtube.com/watch?v=m2wR138lpx8More information about the product is also available at:http://www.be-nimble.com/

2011 Final Rule – Effective Jan. 1, On Nov. 2, Centers for Medicare and Medicaid Services (CMS) released the finalized 2011 Medicare Physician Fee Schedule (MPFS). Peers from all over the country submitted 8,500 comments to CMS regarding the proposed rule but CMS implemented most changes featured in the 1,250-page proposal in the 2000+ Final Rule.

This issue includes basic articles concerning some of the changes that are to take effect January 1, 2011.

The full Final Rule can be downloaded at www.arhcp.org/learn

Want to become active in the Medical Business Journal? Email inquiries to [email protected]

2011 Payment Policies and RatesBelow are some highlights from the Final Rule:The conversion factor (CF) for 2011 has been reduced to $25.5217, which is roughly 30% lower than the current CF of $36.8729. What kind of impact does this have on your practice? Look at it this way, currently the national payment for a level-3 office visit, for an established patient (99213) is $66.74. After the new conversion factor takes effect, the reimbursement will fall to $51.81 – that’s more than a 20% reduction!

Meanwhile, CMS is rebasing and revising the Medicare Economic In-dex (MEI) to use a 2006 base year in place of a 2000 base year. What does that mean? This will shift the MEI to increase practice expense RVUs and malpractice RVUs while leaving work RVUs the same. Therefore, CMS is not making an adjustment directly to the work rela-tive value units (RVU), but instead is increasing the PE RVUs by an adjustment factor of 1.181 and the malpractice RVUs by an adjusted factor of 1.358 (see Addendum B in the final rule). The end result is to promote pay for specialties with high expenses (e.g. diagnostic imag-ing, radiation oncology, etc)

The final rule also discusses CMS’ analysis of practice expense geo-graphic practice cost index (PE GPCI) data and methods as it incor-porates new data as part of the sixth GPCI update, while keeping the GPCI cost share weights the same.

A large number of RVU changes will also take effect in 2011 with CMS adopting recommendations by the AMA’s RUC (Relative Unit Update Committee). The RUC is the AMA’s effort to revalue codes that were deemed as “potentially misvalued”.

The 2011 MPFS final rule with comment period will appear in the Nov. 29th Federal Register.

Stay tuned for more information regarding the final rule in upcoming issues of the Medical Business Journal.

http://www.gao.gov/new.items/d10737.pdf

http://www.youtube.com/watch?v=m2wR138lpx8

http://www.youtube.com/watch?v=m2wR138lpx8

http://www.be-nimble.com/

http://www.arhcp.org/learn

mailto:editorsMBJ%40mmiclasses.com?subject=2011%20Final%20Rule%20-%20MBJ


Medical Business Journal Medical Business Journal


E/M: Observation CodesNew: 99224

9922599226

Surgery Section: Integumen-tary System Codes

New: 110451104611047

Revised: 110101101111012110421104311044

Deleted: 1104011041

Surgery Section: Muscu-losketal System CodesNew: 22551

22552299142991529916

Revised: 2000520664209302093122315228512706527066270672707027071

Deleted: 20000Surgery Section: Respi-ratory System CodesNew: 31295

3129631297

31634Surgery Section: Cardio-vascular System CodesNew: 33620

3362133622

Revised: 334113386033863338643490035471355263562637205372063720737208

Deleted: 33861354543545635459354703547335474354803548135482354833548435485354903549135492354933549435495372203722137222372233722437225

372263722837229372303723137232372333723437235

Surgery Section: Hemic and Lymphatic System CodesNew: 38900

Deleted: 39502395203953039531

Surgery Section: Diges-tive System CodesNew: 43283

433274332843333433344333543336433374333843753437544375543756437574941249418

Revised: 436054748047490494194942149422

Deleted: 43324

CPT Changes 2011

433264360049420

Surgery Section: Urinary System CodesNew: 53860Revised: 50250

50542Surgery Section: Male Genital System CodesRevised: 55866

55876

Surgery Section: Female Genitial System CodesNew: 57156Revised: 57155

Surgery Section: Ner-vous System CodesNew: 61781

61782617836456664568645696457064611

Revised: 644796448064483644846457564708647126471364714

Deleted: 6179564573

Surgery Section: Eye and Ocular AdnexaNew: 65778

65779



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6617466175

Revised: 65780667616980169802

Radiology CodesNew: 74176

74177741787688176882

Revised: 7595475960759627596477003

Deleted: 75992759937599475995759967635076880

Pathology and Labora-toryNew: 80104

829308386184112855988648186902875018750287503879068812088121881778836388749

Revised: 82952855978648087901881728833288334

Deleted: 82926829288690389100891058913089132891358913689140891418922589235

Medicine Section Codes:New: 90460

904619064490664906669066790668908679101391117921329213392134934519345293453934549345593456934579345893459934609346193462

9346393464935639356493565935669356793568958009580196446

Revised: 9056090662906639067091010932249322593226932279322893229932689327093271921729585795953959569759797598

Deleted: 904659046690467904689100091011910129105291055911059112392135930129301493230

9323193232932339323593236932379350193608935109351193514935249352693527935289352993539935409354193542935439354493545935559355696445

Category II:New: 0545F

1200F1205F1400F3008F3015F3038F3293F3294F3323F3324F3328F3650F3700F3720F4004F4063F4255F4256F4324F




4325F4326F4328F4330F4340F4400F5200F6070F6080F6090F

Revised: 3110F3111F3112F3216F4047F4048F7010F

Deleted: 1127F1128F

Category IIINew: 0253T

0208T0209T0210T0211T0212T0213T0214T0215T0216T0217T0218T0219T0220T0221T0222T0223T0224T0225T0226T0227T0228T0229T0230T0231T

0232T0233T0234T0235T0236T0237T0238T0239T240T0241T0242T0243T0244T0245T0246T0247T0248T0249T0250T0251T0252T0254T0255T0256T0257T0258T0259T

Revised: 0184T0191T

Deleted: 0016T0017T0104T0105T0130T0140T0160T0161T0176T0177T0187T0193T0203T0204T

Another HHS Federal Funding Opportunity$335 million to increase access to primary health care

Under the Expanded Services (ES) initiative, the availability of $335 million for existing community health centers was announced Oct 26. The funds intend to help the health centers accommodate more patients, regardless of the patient’s insurance status.

This action is in line with the Department of Health and Human Services’ (HHS’s) focus on preventative and primary health care. Applicants for this funding must demonstrate how these funds will be used to increase healthcare access to underserved populations.

The following categories of health centers are eligible:

• Community Health Centers (CHC) Section 330(e)• Migrant Health Centers (MHC)-Section 330(g)• Health Care for the Homeless (HCH)-Section 330(h)• Public Housing Primary Care (PHPC)-Section 330(i)

Applications are due by 8 pm ET, January 6, 2011. Information on how to apply for this funding is available at:http://bphc.hrsa.gov/es/

HHS Announces “Early Innovator” GrantsCompetitive funding for States to develop health insurance Exchanges

Health insurance Exchanges are set to open 2014 and only one thing is left to do: actually make them. To help accomplish this elusive goal, The Department of Health and Human Services (HHS) has announced a competitive funding opportunity for States wishing to lead the way.

The Exchanges are intended to be one-stop-shopping centers for health insurance, which will drive down prices for individuals and small businesses. However, in order to actualize this goal, a strong and efficient IT infrastructure is needed. The grants, which will be awarded Feb. 15, 2011 to up to 5 States, are intended to fund the development of this IT infrastructure. The States receiving the grants will need to develop models serving as blueprints by which the rest of the country can develop the Exchanges.

The focus emphasized by HHS is to make the exchanges consumer friendly. The grants will be awarded to States which best demonstrate this, while keeping cost-effective use of tax dollars in mind.

http://bphc.hrsa.gov/es/



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ICD-10 Preparation: Provided CMS’ previous track record for implementation (remember NPI?), the 2013 compliance date may not spark much urgency for providers across-the-board. However, according to professionals, trust that CMS has their act together on this one. In short, for those who are not ready when the “switch” flips on October 1, 2013, the penalty will simply be: you won’t get paid.

As a matter of fact, there is an even earlier deadline you need to consider – January 1, 2012. This is when practices’ must fully adopt HIPAA Transactions and Codes Sets version 5010. This conversion is required before you can switch to the new ICD-10 coding system. CMS has promised to be ready to test 5010 one full year before the compliance date. This is reason enough to believe the October 1, 2013 deadline will stand, and you should not believe rumors of enforcement delays. If you haven’t started already, you will want to aggressively begin making implementation plans today or begin looking for another job.

Don’t mistake the 5010 adoption for the full ICD-10 implementation. The move to ICD-10 is not merely a software upgrade. The new list of ICD-10 codes will be exponentially more detailed than the current ICD-9. With as much detail on the horizon, practices will have to think about whether superbills will remain practical for use. On the same note, don’t count on an ICD-9/ICD-10 crosswalk to save you from being unprepared either. The government has adopted a standard crosswalk – yes, but there is no guarantee that private health plans will follow. Furthermore, roughly 20% of the new codes are unable to be crosswalked!

Here are some suggested starting points:

Get in touch with your vendors to determine software, hardware and other upgrades you will need for the conversion. How much will it cost under your contracts? Outline timelines for testing and other implementation steps.

Contact your health plans to discuss testing and other steps they are taking on their end.

Set a budget and arrange training for the appropriate personnel. Re-search has varied about how much ICD-10 implementation will cost. An MGMA study determined the average, three-physician practice can expect to spend somewhere around $80K-$85K on education, process analysis and other changes. ICD-10 professionals advise considering teaming up with local practices to coordinate on-site trainings to offset some of this cost.

For ICD-10 questions or 5010 vendor recommendations, please contact [email protected]

HCPCS 2011: Sneak PeekThe Centers for Medicare and Medicaid Services (CMS) posted 2011 HCPCS II changes, which include 147 new codes and modifiers and more than 286 deleted codes. Changes also include the addition of pass-through codes, a large number of G procedure/professional ser-vice codes, and many injectable drugs.

OverviewDeleted Codes:Of the 286 deleted codes for 2011, the majority are in the G codes sec-tion (between G0430 and G8521). This includes procedures/professional services like the following: •Diabetic, heart failure and coronary artery disease services; •Osteoporosis and hearing assessment; •Urinary incontinence; •E-prescribing system codes; •Intraocular pressure; •ESRD

C Codes: E Codes: C9255 E0220C9256 E0230C9258-C9269 E0238C9271

There are many injection code addition and deletions in the code range J0558 – J0580 for penicillin G benzathine injection codes. There are also many skin protection wheelchair seat cushion K codes deleted, as well.

Additions: •Q codes Q4117-Q4121, to support healing of burns or ulcers •Q flu vaccination codes for patients 3 years and older •Skilled services codes (G0162-G0164) •G tobacco/smoking related codes •Risk-adjusted functional status change residual score G codes •G blood pressure codes

Description Changes: •Skin graft codes Q4101-Q4116 (pain assessment and accept-able EHR system G codes) have received changes to their long descrip-tions. •Wheelchair code, K0669, has been changed as well.

These are only part of the changes in store for 2011. To view all HCPCS Level II code changes for the New Year, the Alphanumeric Index and Table of Drugs, go to:https://www.cms.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp

mailto:ICD10%40mmiclasses.com?subject=ICD-10%20Preparation%20-%20MBJ

https://www.cms.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp

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CLIA Waived Tests for First Quarter 2011

Centers for Medicare and Medicaid Services (CMS) updated its list of waived tests approved by the Food and Drug Administration (FDA) under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) on Nov. 5th. To ensure accurate claims payment, CMS instructed Medicare administrative contractors (MACs) to do likewise and clinical diagnostic labs should follow shortly thereafter.

In order to perform each test, CLIA regulations require facilities to be appropriately certified.

Here is a chart of the latest tests approved by the FDA under CLIA. Effective January 1, 2011, the CPT codes for the tests listed below must have the QW modifier to be recognized.

Notice to Patients:Medicare Open Enrollment

Starting November 15, all Medicare beneficiaries can choose a new Medicare plan or simply review their current coverage. Starting Janu-ary 2011, thanks to the Affordable Care Act (ACA) most people with Medicare will be provided with important new benefits including a lower cost on brand name drugs for those who fall into the coverage gap, free annual wellness visits and free mammograms, colonoscopies and other screenings.

For more information on Open Enrollment, go to: http://www.medicare.gov/navigation/medicare-basics/open-enrollment.aspx

For more information on ACA, go to: http://www.healthcare.gov/foryou/seniors/strengthening/index.html

Medical Business JournalVolume 1, Issue 2

Managing Editor Jennifer Donovan, RMC, CPC, RMMAssistant Editor Christopher MyersContributors Christopher Myers Jennifer Donovan, RMC, CPC, RMM Mike Calkins, ADN, RMCLayout and Design Chris RottmannProduction Clockwork Graphics

Medical Business Journal is a monthly publication available through subscription for $99.95 per year or $159.95 for two years (additional copies and reprints are available for $20/issue). The Medical Management Institute is not affiliated in any way with the Department of Health and Human Services, Medicare, or the Centers for Medicare and Medicaid Services. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting or other professional services, and is not a substitute for individualized expert assistance. The CPT codes, descriptors, and modifiers are copyrighted by the American Medical Association. For more information, please call MMI at 1-866-892-2765.

CPT Code Effective Date DescriptionG0430QW Jan. 1, 2010 American Screening Corpora-

tion One Screen Drug Test Cups84443QW Mar. 2, 2010 Aventir Biotech LLC, Forsure

TSH Test (Whole Blood)84443QW Mar. 4, 2010 BTNX G0430QW Apr. 21, 2010 CLIAwaived, Inc. Rapid Drug

Test Cup (OTC)G0430QW Apr. 21, 2010 Millennium Laboratories Clini-

cal Supply, Inc. Multi-Drug Pain Med Scren Cup

G0430QW May. 10, 2010 US Diagnostics ProScreen Drugs of Abuse Cup (OTC)

G0430QW Jul. 1, 2010 Ameditech, Inc. ImmuTest Drug Screen Cup

G0430QW Jul. 4, 2010 Quik Test USA, Inc. Multi-Drug of Abuse Urine Test

G0430QW Jul. 4, 2010 Screen Tox Multi-Drug of Abuse Urine Test

82274QW, G0328QW

Jul. 8, 2010 Consult Diagnostics Immuno-chemical Fecal Occult Blood Test (iFOBT)

G0430QW Jul. 19, 2010 Alfa Scientific Designs, Inc. Instant-View Drug of Abuse Urine Cassette Test

G0430QW Jul. 19, 2010 Alfa Scientific Designs, Inc. Instant-View Drug of Abuse Urine Cup Test

G0430QW Aug. 18. 2010 America Screening Corpora-tion Reveal Multi-Drug Testing Cups

87880QW Aug. 18, 2010 PSS Consult Doagnostic Strep A Dipstick

http://www.medicare.gov/navigation/medicare-basics/open-enrollment.aspx

http://www.medicare.gov/navigation/medicare-basics/open-enrollment.aspx

http://www.healthcare.gov/foryou/seniors/strengthening/index.html

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The Registered Medical Manager Online CertificationSample TopicsGoals & Strategic Planning Setting GoalsPersonal GoalsProfessional Goals Practice Goals Goal Statements Planning for Success

Marketing and Medicine Marketing and Healthcare Patient Relations Practice Newsletters Survey for Managed Care Patients

Benefits & Wages Minimum Wage LawsHealthcare Benefits COBRA ERISA

Compliance Overview What is Compliance? Structure of the Compliance Plan Internal Auditing & Monitoring Process Developing a Disciplinary Standard & Guidelines

Leadership & Management Leadership: Be a Big Thinker A Philosophy of Leadership Personnel & Policies Management Reporting

LEARN MORE ABOUT THE REGISTERED MEDICAL MANAGER PROGRAMCall: 866.892.2765 or visit us online: www.mmiclasses.com/RMM.html

Each student is assigned a course advisor and an instructor. The instructor will be your main point of contact throughout the duration of the program. Any time you have an issue or career question, you can contact your course advisor.

The coursework is all self-paced. You can move through the material as your schedule allows, call into your instructor when you have questions or discuss topics with other students online.

Using the Webex application, Instructors can conduct live presentations when needed. Also, you will find course materials and reference manuals are included in your tuition fee. You can also use it to access the school’s online classroom!

Financial Outcomes and Controls Budgeting Cash Flow Management Receipt Controls Internal Auditing and Billing Controls Management Review Guidelines

Compliance Coding & Billing Coding & Billing Modifiers Retention of Records Educational Training in the Medical Practice

Organizations/Income Distribution Practice Organization Physicians as Managers Executive Committees Income Division Formula

Just AddedHealth Care Reform ImpletementationExplanationEffective Dates

http://www.webex.com/

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mbj-dec-2010-mmi

Documents

effectiveness of nqf

endorsing quality measures

quality measurement

required annual review

gao report

national strategy

national level

comprehensive review